A retrospective analysis of a consecutive series of patients treated with krypton red laser (KRL) photocoagulation for subretinal neovascularization (SRN) secondary to drusen-related macular degeneration (DMD) was carried out to investigate the frequency and nature of recurrent neovascularization (recurrence). A classification of various types of recurrences based on the clinical and fluorescein angiographic features and the onset of their appearance in the postoperative course was used in this study. Patient, fundus, and membrane variables were examined in search of relevant high risk factors predisposing to recurrences. The membrane's proximity to the fovea and its relative lack of pigmentation were individual factors which were associated with a high risk of recurrence (P < 0.05 for distance and P = 0.005 for color). Multivariate analysis also indicated that a greater distance from the fovea (P < 0.05) and a darker color (P = 0.002) were favorable features to the primary membrane, reducing the probability of a recurrence. Overall, 39% of the patients experienced recurrences (23% of the patients had treatable recurrences and 16% had non-treatable recurrences extending under the center of the fovea). The membranes recurred predominantly at the margin of the photocoagulation burn. The recurrences were also noted relatively early in the postoperative course, 65% within two months after photocoagulation of the primary membrane. The fluorescein angiographic and clinical nature of these membranes and the visual effect of retreatment are also discussed in the paper. [Key words: drusen, fovea, krypton red laser photocoagulation, macular degeneration, recurrent neovascularization, retinal pigment epithelium, subretinal neovascularization.] Ophthalmology 92:1059-1074, 1985
Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York.
Presented at the Eighty-ninth Annual Meeting of the American Academy of Ophthalmology, Atlanta, Georgia, November 11–15, 1984.
Supported in part by the LuEsther T. Mertz Retinal Research Fund of the Manhattan Eye, Ear & Throat Hospital and The Macular Foundation.
Reprint requests to Lawrence A. Yannuzzi, MD, 525 Park Avenue, New York, NY 10021.